Medicaid Expansion Reduces Uninsured Hospital Visits

States that chose to expand their Medicaid services under the Affordable Care Act are seeing significant reductions in uninsured hospital visits.

A review of publicly traded hospitals’ earnings calls by The Washington Post shows that uninsured (self-pay) hospital visits dropped between 28 and 33 percent at some of the largest hospital systems in the country in states that took advantage of the federally-funded Medicaid expansion. At the same time, Medicaid admissions increased anywhere from 4 to 22 percent at those same facilities.

The story is less encouraging in the 24 states that refused Medicaid expansion. Non-expansion states saw upticks in both self-pay ER visits and uninsured admissions, and some actually had decreased Medicaid admissions. Hospitals have pushed for Medicaid expansion, arguing that even Medicaid’s lower reimbursement rates are better than what they (often do not) collect from uninsured patients.

Many states have also dragged their feet in preparing for the ACA’s broader implementation of presumptive eligibility, a system by which hospitals can preemptively enroll families with qualifying income in a Medicaid program to provide them care up-front. The state Medicaid agency then processes the complete application, putting many otherwise uninsured families on the path to coverage.

There are troubling financing implications for the uneven expansion of Medicaid around the country. The increase of self-pay patients in non-expansion states increases the amount of potentially uncollectible funds owed to those hospital systems and facilities, which also raises the risk to a healthcare factoring company.

Factors collect from insurance, Medicaid, and Medicare, but not from individual patients; therefore, more self-pay accounts reduce the number of valid invoices that a hospital can factor to offset the gap in federal reimbursements. If the above numbers continue their current trajectories, there is a very real possibility that healthcare factoring companies may tighten their requirements for working with clients in non-expansion states – or decline to work with them altogether.

We will continue to provide updates on Medicaid expansion and its impact on facilities in both expanded and non-expanded states.

PRN Funding offers healthcare factoring services to vendors providing a variety of healthcare services to hospitals and other healthcare facilities. Learn more about the different healthcare factoring options we provide and fill out our easy online application to begin.

ACA: Enrollment Passes 8 Million, Uninsured Rate Lowest Since 2008

The Obama administration announced last month that enrollments in the ACA exchanges topped eight million.

As of April 19, 8.019 million people had signed up for Obamacare plans – an impressive national average despite a large disparity between individual state enrollments. Some states missed their enrollment targets by a wide margin, while others more than doubled their goal.

In addition to marketplace policies, 4.8 million consumers enrolled in Medicaid plans in their states between October 1 and April 19, and nearly five million consumers purchased policies outside the exchanges. Altogether, the administration estimates that up to 18 million consumers have purchased new healthcare policies during the six-month enrollment period measured.

While some consumers may have been previously insured, a majority of marketplace users who requested subsidies self-reported that they did not have insurance when they applied. Further evidence is in the numbers: a Gallup poll reports that the uninsured rate by the end of the first quarter is down to 13.4 percent, the lowest level since the recession began in 2008 and down from 17.3 percent in January.

Health care executives presented preliminary payment information to the House Energy and Commerce oversight subcommittee last week that shows between 80 and 90 percent of new premiums are paid, well above the 67 percent reported by members of the same committee the week prior.

PRN Funding offers healthcare factoring solutions to help providers control costs – including health care. Learn more about our healthcare factoring services and apply for a free factoring quote today!

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ACA: The Cost of Non-Enrollment

With the March 31 enrollment deadline looming, the Obama administration is working overtime to encourage uninsured Americans to purchase coverage in state or federal marketplaces. Approximately 50 percent of uninsured consumers plan to remain uninsured for a number of reasons, raising the important question: what is the cost of not enrolling in a valid healthcare plan?

Required Coverage

ACA-compliant health insurance policies must meet the law’s requirements for minimum essential coverage, which includes all government-administered plans as well as new and grandfathered employer plans and coverage offered by universities. While other plans may also meet the minimum essential coverage standard, consumers who hold non-compliant policies will be subject to the same penalty as uninsured consumers. Vision and dental-only plans, workers’ compensation, and healthcare savings accounts do not qualify as compliant policies.

Most consumers are required to carry a compliant healthcare plan; however, the ACA provides a number of exemptions for consumers who are unable to afford a qualifying plan or who fit other criteria.

How does the penalty work?

The 2014 penalty for uninsured consumers is the greater of $95 per adult/$47.50 per child, up to $285 per family, or one percent of your family’s gross adjusted income above the tax return filing threshold. (If your income is not high enough to require a tax filing, you are exempt from the individual mandate.)

Despite the focus on the $95 flat fee, more consumers earn more than the $19,650 that matches the $95 fee and will be required to pay a higher amount. For example, a family earning $50,000 annually would have to pay $297, or one percent of their eligible AGI – $12 more than the flat fee maximum. Though penalties are capped at approximately $9,800, many families do not make enough to meet this cap and will be on the hook for their entire penalty.

Can I enroll after the March 31 deadline?

Your ability to enroll in the federal marketplace after the deadline depends on a number of conditions. Currently, consumers who have attempted to purchase a healthcare plan prior to March 31 will be granted a limited extension to complete their enrollment. Once extensions have ended, you must wait until the next open enrollment period unless you have a change in life situation that qualifies you to enroll.

If you signed up for a policy before March 31 that features a gap in coverage (i.e. does not start immediately), you will not have to pay the penalty. Also, if you are without insurance for less than three months after the deadline you will not have to pay the penalty. For periods longer than three months but less than a year, you will be responsible for each month’s portion of the annual penalty for as long as you are uninsured.

For questions about your specific healthcare needs and plans that are available, visit Healthcare.gov.

With Deadline Looming, ACA Enrollments Fall Short

One week from today marks the Affordable Care Act deadline for individual consumers to have an ACA-compliant policy from their employer or the online health marketplaces. Consumers who have not enrolled in coverage by March 31 will face a penalty on their taxes and will be prevented from signing up for subsidized healthcare until next year.

However, despite the time crunch only a quarter of Americans at this point had accessed the exchanges by January and many thousands of others are still uninformed about their responsibility to obtain coverage. Unfortunately, the majority of uninformed consumers are those who would benefit the most from tax credits and subsidies.

Misinformation is a major source of public reluctance to use the online health exchanges. The political debate over the Affordable Care Act is well-documented, and additional state laws governing the implementation of the individual mandate have further complicated the process.

The Obama administration is elbow-deep in a campaign to inform consumers and encourage them to apply for insurance. Volunteers are contacting households via phone banks, email, and door-to-door canvassing with pamphlets and applications. Canvassers hope that by educating consumers they will be able to dispel some of the myths surrounding the cost of health care plans and demonstrate the importance of having a compliant policy by next week’s deadline.

PRN Funding offers factoring services to cover expenses such as health insurance premiums for companies that work with hospitals and other medical facilities. To learn more about healthcare factoring, contact us today.

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Obamacare Enrollment Quickens Pace in March

Things didn’t look promising for the Affordable Care Act enrollment numbers in the beginning of March. Reports estimated that one sign up must be completed every 1.4 seconds in order to reach the enrollment goal of 6 million. As of March 1, 2014, sign-ups were sitting at 4.2 million. The enrollment period concludes March 31.

However, the pace is quickening. A rush of sign-ups occurred within the first two weeks of March bringing the enrollment numbers to over 5 million. If enrollment keeps up, the Obama administration may come close to 6 million within the first year. Before the ill-fated healthcare.gov rollout, the administration hoped to achieve 7 million sign-ups. The number has been adjusted to address the numerous technical issues.

The information on demographics has not been released. To keep consumer costs down, it’s imperative that a mix of young and old participate in the insurance marketplace. As of last month, it seemed as if only 25% of health insurance buyers fell into the 18-34 age range. Without the young and healthy, insurance premiums are anticipated to rise in 2015. Insurers and experts predict a variety of factors to raise premiums, including the administration’s decision to allow people to hold onto skimpy plans and other delays that accompanied the botched rollout.

Another Obamacare Delay Extends Skimpy Plan Coverage Until 2016

Another Obamacare delay? Indeed. The Obama administration put off another key aspect of the Affordable Care Act on Wednesday and will allow insurance companies to continue selling skimpy plans that don’t meet the new, stricter standards. This is the second delay that involves these types of plans. It was first delayed in 2013 after upset consumers realized their health plans could be cancelled because they didn’t meet minimum requirements.

The series of delays leaves employers wondering how they should implement the healthcare mandate. The employer mandate has also been delayed twice and many businesses won’t have to comply until 2016. That is, if more delays aren’t on the horizon.

Fewer Americans are gaining coverage under the Affordable Care Act than was predicted. Between the catastrophic rollout of Healthcare.gov and the decisions of many states not to expand Medicaid eligibility, millions of Americans are still without coverage. Younger consumers are failing to enroll, which was a key component to ensure the cost of healthcare coverage remains affordable.

The law was intended to provide affordable coverage to all, but it’s only predicted to make a small dent in the amount of uninsured Americans in 2014. The Congressional Budget office estimates that 30 million Americans may still be uninsured by 2020.

Young Consumers Not Using Healthcare Exchanges

According to reports from the Obama administration about healthcare enrollment in the online marketplace through January, only 25 percent of consumers who have purchased healthcare plans fall into the critical 18-34 demographic. The figure is far lower than the number of young consumers who have created accounts on the exchanges.

Many experts and administration officials have touted the importance of young consumers using the healthcare exchanges to balance the cost of care for older patients. While insurance companies can vary costs to a certain degree based on age, it is not enough on its own to control the difference in healthcare needs between the two demographics. A continued slump of young enrollees could prompt insurance providers to raise premiums significantly within the coming years, which would put a strain on the entire system.

One potential explanation for the lack of enrollment in the younger demographic is its overlap with another provision of the Affordable Care Act which allows parents to keep adult children up to age 26 on their own health insurance. The overlap affects nearly half of the exchanges’ target demographic, specifically college students and young post-graduates.

The federal government is not alone in fretting over low enrollment; states running their own exchanges, such as Minnesota, are also experiencing enrollment that skews toward the older demographic.

If you fear rising healthcare costs could threaten your company’s cash flow, consider healthcare factoring through PRN Funding. We can create a customized factoring program to fit your company’s needs and offset your cash concerns, with approval in as little as 3-5 business days. Apply now to get started.

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ACA: Employer Mandate Receives New Extension

Earlier this week, the IRS released its final rule on the employer mandate. Among provisions regarding employee transition periods and how to classify employees for counting purposes was a new extension of the employer mandate.

After a previous extension moved the start date to January 1, 2015, the mandate is now postponed until 2016 for employers with 50-99 full-time employees. In addition, while large companies with more than 100 employees are still subject to the mandate in 2015, they only have to offer coverage to 70 percent of their full-time workforce for the first year the mandate is in effect.

The Obama administration explained the extension as an effort to give affected companies additional time to come into compliance with the mandate. Two percent of U.S. companies are classified as mid-size and two percent are large, but those companies employ as much as 70 percent of the total labor force in the United States.

Criticism of the announcement centers on frustration that the individual mandate, seen by many to be more of a burden than the employer mandate, went into effect on its originally schedule date of January 1, 2014. Consumers still have six weeks, until March 31, to enroll in a qualifying healthcare plan. The delay of the employer mandate could push a number of those consumers to the online marketplaces if they are unable to obtain a policy through their employer.

The staffing industry is also frustrated with other provisions of the IRS final rule, which limit staffing agencies’ ability to classify their employees as variable-hour or to take advantage of look-back periods to determine their status for insurance purposes. This could potentially raise healthcare costs for these agencies if they are required to provide coverage to employees who are later determined to be variable-hour or part-time.

If you have a nurse staffing agency or work in the medical field and are worried about rising healthcare costs, PRN Funding’s healthcare factoring program can help you turn your receivables into immediate cash. Learn more about healthcare factoring and contact us to get started today.

New Obamacare Plans Result in Drug-Cost Sticker Shock

With the rollout of Obamacare, many patients with chronic illnesses are taking advantage of the new healthcare law. However, these patients, who are projected to be some of the biggest beneficiaries of the new initiative, may encounter sticker shock with drug costs. Under the new law, out-of-pocket expenses associated with the new exchanges could vary widely.

The new healthcare act enables patients with pre-existing conditions to obtain affordable coverage. Additionally, these patients can’t be penalized with higher rates than healthier participants. In terms of out-of-pocket expenses, the maximum set for individuals is $6,350, and $12,700 for families. Once these amounts are reached, insurers will then pick up the full tab.

Nevertheless, patients taking costly prescription drugs are more likely to reach these levels fast. While certain medications for serious conditions can cost thousands of dollars a month, some plans under the new exchanges may place as much as 50 percent of the cost on patients. Basically, plans with lower monthly premiums require patients to bear higher portions of drug costs.

In addition to premiums, many other factors impact drug costs for patients. Among these factors is a drug’s tier, or level of coverage. Tiers vary from plan to plan, and can be classified into different categories: generic, brand, preferred and specialty drugs. In order to determine tiers, insurers and drug manufacturers negotiate prices for each particular drug. Drug costs are greatly impacted by these tiers, which can make all the difference in patient costs.

As a result, high price tags and costly co-pays are associated with high-tiered drugs. According to insurance-industry experts, many businesses are anticipating larger numbers of sicker, costlier patients to sign up for the exchanges. This trend could lead to financial troubles if an inadequate number of healthier customers sign-up and balance out those costs. Regardless, insurers are not allowed to impose higher charges on chronically ill patients. Therefore, in order to keep monthly premiums lower, patients are forced to pay more for high-tier drugs.

Obama: Individuals May Keep Cancelled Insurance Policies for Now

Obamacare established new standards for health insurance coverage in the U.S. As a result, millions of Americans were presented with policy cancellation notices, forcing many people to drop their current coverage and opt for a new health insurance plan. In order to help alleviate this troublesome situation, the president made an announcement yesterday that his administration would not enforce the Obamacare provisions that led to policy cancellations throughout the country.

Therefore, individuals who were in favor of their current coverage plans may be able to keep them for another year. However, once midterm elections are complete, plans that are not in accordance with the new healthcare law will get canceled again.

The new transitional policy introduced by the administration will enable people who were happy with their insurance to remain on their current plans, as long as their policies were effective on Oct. 1 of this year. Furthermore, another stipulation for this newly-enacted policy is that insurers provide free advertisements for their competitors on Obamacare’s online exchanges.

Aside from the 25 million Americans who opt for their own coverage through the individual market, several employees covered by employer-based insurance will also encounter cancellations. Currently, 156 million people obtain healthcare through their employers.

In addition to this particular provision, there are many other  aspects  of Obamacare that will not be enforced yet, such as postponing the employer mandate for a year. These and other unilateral actions are being announced by the White House, since the administration wants to avoid the potential for Congress to pass legislative amendments to the new healthcare law.

In order for this cancellation fix to actually work, insurers must find some way to rush their old products into the marketplace by January 2014. This will be extremely difficult for insurers to pull off. Since new reimbursement rates for 2014 would have to be negotiated with doctors and hospitals, insurers would have to submit these plans to state insurance regulators in order to obtain approval.

Despite the proposed cancelation fix, a new Gallup poll released this week revealed an increase in disapproval rates for the Affordable Care Act, rising from 47 percent to a high of 55 percent. Additionally, the president’s overall approval ratings have fallen between the high 30s and 40s.

Even with the change, the administration is leaving it up to each individual state to determine whether or not residents can keep coverage plans that are not in accordance with the new healthcare initiative. As a result, state insurance commissioners, along with other health policy experts, have established the fact that insurance plans will greatly vary across the country.

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